Individual
STACIA ROUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
NM 571 BLDG 28, EL RITO, NM 87530
(575) 581-4728
(575) 581-0030
Mailing address
PO BOX 237, EL RITO, NM 87530-0237
(575) 581-4728
(575) 581-0030
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
M10379
NM
1041C0700X
Clinical Social Worker
Primary
C-11362
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49475053
—
NM
Enumeration date
01/30/2020
Last updated
09/23/2020
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